This situation creates a risk of bronchopulmonary infection, chronic cough, and bronchospasm. Br J Anaesth 2001; 86:21722, Mark LC: Treatment of laryngospasm by digital elevation of tongue (letter). The vocal cords are two fibrous bands inside the voice box (larynx) at the top of the windpipe (trachea). It is a primitive protective airway reflex that exists to . margin-right: 10px; Anaesthesia 1998; 53:91720, Ko C, Kocaman F, Aygen E, Ozdem C, Ceki A: The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children (17.4/1,000) than in the general population (8.7/1,000).2,5,,7In fact, the incidence of laryngospasm has been found to range from 1/1,000 up to 20/100 in high-risk surgery (i.e. Afferent nerves converge in the brainstem nucleus tractus solitarius. Even though laryngospasms are scary when they happen, they usually dont cause serious problems. min-height: 0px; . The final decision depends on the severity of the laryngospasm (i.e. and bronchomotor reflexes, indicating that not only skeletal but also smooth muscles are involved in upper airway reflexes.19. other information we have about you. For example, if laryngospasms are linked to GERD, then treating chronic acid reflux can also reduce your risk for laryngospasm. To avoid significant morbidity and mortality, the use of a structured algorithm has been proposed.8,70One study suggests that if correctly applied, a combined core algorithm recommended for the diagnosis and management of laryngospasm would have led to earlier recognition and/or better management in 16% of the cases.70These results should encourage physicians to implement their own structured algorithm for the diagnosis and management of laryngospasm in children in their institutions. The child was placed over a forced air warmer (Bear Hugger, Augustine Medical, Inc., Eden Prairie, MN). More specifically, laryngeal closure reflex involves the laryngeal intrinsic muscles responsible for vocal folds adduction, i.e. ANESTHESIOLOGY 2001; 95:103940, Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL: Dose response to intramuscular succinylcholine in children. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. As your vocal cords slowly relax and open, you may hear a high-pitched sound (stridor). However, onset time to effective relief of laryngospasm is shorter than onset time to maximal twitch depression, enabling laryngospasm relief and oxygenation (within 60 s) in less time than time to maximum twitch depression.55Therefore, intramuscular succinylcholine is the best alternative approach if IV access is not readily available.56Another alternative for succinylcholine administration is the intraosseous route. (https://pubmed.ncbi.nlm.nih.gov/31587728/), (https://academic.oup.com/bjaed/article/14/2/47/271333). Breathe in slowly through your nose. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Pediatr Pulmonol 2010; 45:4949, Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal RS: Is there a role of a small dose of propofol in the treatment of laryngeal spasm? information submitted for this request. The apneic reflex varies as a function of age. Laryngospasm is potentially life-threatening closure of the true vocal chords resulting in partial or complete airway obstruction unresponsive to airway positioning maneuvers. Realistic training with high-fidelity mannequins and other types of simulations represent unique educational tools that can be fully integrated in a residency program based on competency.72Similarly, simulation-based education is being increasingly used for continuing medical education. A detailed history should be taken to identify the risk factors. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. #mc-embedded-subscribe-form input[type=checkbox] { From: Encyclopedia of . An IV line was obtained at 11:15 PM, while the child was manually ventilated. Airway simulators and high fidelity mannequins are important teaching tools.73Simple bench models, airway mannequins, and virtual reality simulators can be used to learn and practice basic and complex technical skills. Anaphylaxis (+/- Laryngospasm) A 7-year-old male presents with wheeze, rash and increased WOB after eating a birthday cake. In this case, some equipment has high usage demands and becomes scarce throughout the unit. Recognizing laryngospasm - laryngospasm can occur spontaneously and be life-threatening, making it important that you be able to recognize it immediately. These risk factors can be patient-, procedure-, and anesthesia-related (table 1). The brainstem nucleus tractus solitarius is not only an afferent portal, but has interneurons that play an essential role in the genesis of upper airway reflexes.19Little is known about the centers that regulate and program these reflexes. Other pharmacologic agents have been proposed for the prevention and/or treatment of laryngospasm, including magnesium,17doxapram,67diazepam,68and nitroglycerine.69However, because of the small number of patients included in these series no firm conclusions can be drawn. You may opt-out of email communications at any time by clicking on Several studies suggest that deep extubation reduces this incidence, whereas others observed no difference.5,3435In one study, tracheal intubation with deep extubation was associated with increased respiratory adverse events rate (odds ratio = 2.39) compared with LMA removal at a deep level of anesthesia, whereas use of a facemask alone decreased respiratory adverse events (odds ratio = 0.15).35The difference between LMA and ETT was less evident when awake extubation was used (odds ratio = 0.65 and 1.26, respectively). ANESTHESIOLOGY 1963; 24:585, Al-Metwalli RR, Mowafi HA, Ismail SA: Gentle chest compression relieves extubation laryngospasm in children. ANESTHESIOLOGY 2010; 113:2007, Roy WL, Lerman J: Laryngospasm in paediatric anaesthesia. The goal is to slow your breathing and allow your vocal cords to relax. Lancet 2010; 376:77383, Murat I, Constant I, Maud'huy H: Perioperative anaesthetic morbidity in children: A database of 24,165 anaesthetics over a 30-month period. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. Our providers specialize in head and neck surgery and oncology; facial plastic and reconstructive surgery; comprehensive otolaryngology; laryngology; otology, neurotology and lateral skull base disorders; pediatric otolaryngology; rhinology, sinus and skull base surgery; surgical sleep; dentistry and oral and maxillofacial surgery; and allied hearing, speech and balance services. Place a straw in your mouth and seal your lips around it. This scenario illustrates the potential risks of not managing your resources properly. First, the introduction of working hour limitations in virtually all Western countries has decreased the number of pediatric cases performed by trainees.71Second, most anesthetics given to children are administered by nonspecialists whose lack of experience and inability to maintain their skill set for children is a problem. GERD: Can certain medications make it worse? Acta Anaesthesiol Scand 2009; 53:19, Larson CP Jr: Laryngospasmthe best treatment. While laryngospasms affect your vocal cords (two bands of tissue housed inside of your larynx), bronchospasms affect your bronchi (the airways that connect your windpipe to your lungs). Their motoneurons are located in the brainstem nucleus ambiguous and the adjacent nucleus retroambigualis. The purpose of this case scenario is to highlight keypoints essential for the prevention, diagnosis, and treatmentof laryngospasm occurring during anesthesia. When it happens, the vocal cords suddenly seize up or close when taking in a breath, blocking the flow of air into the lungs.People with this . Without quick recognition and proper treatment, the patient's airway may occlude, leading to respiratory arrest followed by cardiac arrest. Anesth Analg 1996; 82:7247, Skolnick ET, Vomvolakis MA, Buck KA, Mannino SF, Sun LS: Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. On the other hand, attempts to provide positive-pressure ventilation with a facemask may distend the stomach, increasing the risk of gastric regurgitation. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. This paper discusses a case study where the patient had laryngospasm, it also looks at the pathophysiology, risk factors and management of . suggests that maintenance with sevoflurane was associated with a higher incidence of laryngospasm compared with propofol (relative risk 2.37, 95% CI 1.493.76; P< 0.0001).5In our case, the second episode of laryngospasm occurred while the patient was under light anesthesia. Even though laryngospasm isnt usually serious or life-threatening, the experience can be terrifying. Laryngoscope 2006; 116:1397403, Nishino T, Hasegawa R, Ide T, Isono S: Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. PubMed PMID. A simulation scenario is an artificial representation of a real-world event to achieve educational goals through experiential learning. The patient is unconscious and initially breathing easily with an oral airway in place. Pediatr Emerg Care 1990; 6:1089, Woolf RL, Crawford MW, Choo SM: Dose-response of rocuronium bromide in children anesthetized with propofol: A comparison with succinylcholine. However, if youve experienced laryngospasms in the past, your healthcare provider can determine whats causing them and find ways to reduce your risk. Immediately after extubation, the patient developed inspiratory stridor consistent with laryngospasm; the anesthesiologist had difficulty in mask ventilating the patient, and peripheral oxygen saturation decreased to less than 80%. Propofol depresses laryngeal reflexes33,48and is therefore widely used to treat laryngospasm in children.3,49A study has assessed the effectiveness of a small bolus dose of propofol (0.8 mg/kg) for treatment of laryngospasm when 100% O2with gentle positive pressure had failed.49In this study, propofol was administered if laryngospasm occurred after LMA removal and if it persisted with a decrease in SpO2to 85% despite 100% O2with gentle positive pressure ventilation.49The injection of propofol was able to relieve spasm in 76.9% of patients, whereas the remaining patients required administration of succinylcholine and tracheal intubation.49The success rate of propofol observed in this study is superior to the chest compression technique mentioned previously. Eur Respir J 2001; 17:123943, Holm-Knudsen RJ, Rasmussen LS: Paediatric airway management: Basic aspects. In a more recent series, the overall incidence of laryngospasm was lower8but the predominance of such incidents at a young age was still clear: 50 to 68% of cases occurred in children younger than 5 yr. People with laryngospasm are unable to speak or breathe. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic. As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. Unfortunately, laryngospasms usually happen quickly. The team must initiate usual anaphylaxis treatment including salbutamol for bronchospasm. They can help figure out whats causing them. ANESTHESIOLOGY 1998; 88:114453, Leicht P, Wisborg T, Chraemmer-Jrgensen B: Does intravenous lidocaine prevent laryngospasm after extubation in children? information is beneficial, we may combine your email and website usage information with This content does not have an Arabic version. For instance, coughing can be voluntarily inhibited. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. Larson CP Jr. Laryngospasmthe best treatment. Elsevier; 2021. https://www.clinicalkey.com. For children with URI, cancellation of elective procedures for a period of 46 weeks was traditionally the rule. Laryngospasm (luh-RING-go-spaz-um) is a transient and reversible spasm of the vocal cords that temporarily makes it difficult to speak or breathe. Treatment of laryngospasm. Upper airway disorders. clear: left; ANESTHESIOLOGY 2009; 110:28494, Baraka A: Intravenous lidocaine controls extubation laryngospasm in children. To provide you with the most relevant and helpful information, and understand which #mc-embedded-subscribe-form .mc_fieldset { Furthermore, the efficacy of propofol to break complete laryngospasm when bradycardia is present has been questioned.4In our case, two bolus doses of 5 mg IV propofol (each representing a dose of 0.6 mg/kg) were administered but did not relieve airway obstruction. Second-level studies attempt to document the transfer of skills to the clinical setting and patient care. The progressive signs and symptoms are shivering (36C), confusion, disorientation, introversion (35C), amnesia (34C), cardiac arrhythmias (33C), clouding of consciousness (33-30C), LOC (30C), ventricular fibrillation (VF) (28C), and death (25C). There are data supporting the efficacy of structured courses that integrate airway trainers and high fidelity simulation for airway management training.7677Recent evidence also supports the transfer of technical and nontechnical skills acquired during simulation to the clinical setting.78We therefore strongly encourage the integration of simulation-based training for pediatric airway management, including for the management of laryngospasm. https://www.aaaai.org/conditions-treatments/related-conditions/vocal-cord-dysfunction. These are the reasons why inhalational induction conducted by nonspecialized anesthetists remains associated with an increased risk of laryngospasm.2,5,18In children with hyperactive airways, there are now several arguments in favor of IV induction with propofol versus inhalational induction. The exercise is then followed by a debriefing session during which constructive feedback is provided. Used with permission of John Wiley and Sons. Indian J Anaesth 2010; 54:1326, Behzadi M, Hajimohamadi F, Alagha AE, Abouzari M, Rashidi A: Endotracheal tube cuff lidocaine is not superior to intravenous lidocaine in short pediatric surgeries. Paediatr Anaesth 2008; 18:3037. They can determine the cause of your laryngospasms and recommend an appropriate treatment plan. 5 of 7 This document is not intended to provide a comprehensiv e discussion of each drug. Relative Risk (95% CI) of Laryngospasm in Children According to the Presence of Cold Symptoms, Household exposure to tobacco smoke was shown to increase the incidence of laryngospasm from 0.9% to 9.4% in children scheduled for otolaryngology and urologic surgery.12This strong association between passive exposure to tobacco smoke and airway complications in children was also observed in another large study.13. Laryngospasm is a frightening condition that happens when your vocal cords suddenly seize up, making breathing more difficult. Taking an antacid or acid inhibitor for a few weeks may help diagnose the problem by the process of elimination. Mayo Clinic does not endorse companies or products. In the study by von Ungern-Sternberg et al. ANESTHESIOLOGY 2001; 95:299306, Lakshmipathy N, Bokesch PM, Cowen DE, Lisman SR, Schmid CH: Environmental tobacco smoke: A risk factor for pediatric laryngospasm. Anaesthesia 2007; 62:7579, Tobias JD, Nichols DG: Intraosseous succinylcholine for orotracheal intubation. Laryngospasms are rare and typically last for fewer than 60 seconds. Jun 2005;14(3):e3. ANESTHESIOLOGY 2007; 107:7149, Tait AR, Burke C, Voepel-Lewis T, Chiravuri D, Wagner D, Malviya S: Glycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections. Pulmonary complications. Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection? Laryngospasms are rare. 2021; doi: 10.1016/j.jvoice.2020.01.004. Paediatr Anaesth 2003; 13:437, Schreiner MS, O'Hara I, Markakis DA, Politis GD: Do children who experience laryngospasm have an increased risk of upper respiratory tract infection? These risk factors can be None of the children in the chest compression group developed gastric distension (86.5% in the standard group). This situation has been found to occur in approximately 50% of patients.8The most commonly used muscle relaxant is succinylcholine, but other agents have also been used, including rocuronium and mivacurium.8However, succinylcholine remains the gold standard.4Some authors have suggested the use of a small dose of succinylcholine (0.1 mg/kg) but there is a lack of dose-response study because the study included only three patients.52Therefore, we recommend using IV doses of succinylcholine no less than 0.5 mg/kg. These cookies do not store any personal information. } Collins S, Schedler P, Veasey B, Kristofy A, McDowell M. These cookies will be stored in your browser only with your consent. 21,22. . Shortness of breath. The breathing difficulty can be alarming, but it's not life-threatening. Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea. Laryngospasm: Stimulation of vagus nerve during light anesthesia (Superior Laryngeal n, pharyngeal br of vagus, recurrent laryngeal below cords). Usually, laryngospasm resolves and the patient recovers quickly without any sequelae. Pulm Pharmacol 1996; 9:3437, Shannon R, Baekey DM, Morris KF, Lindsey BG: Ventrolateral medullary respiratory network and a model of cough motor pattern generation. Prevention of laryngospasm. Paediatr Anaesth 2008; 18:3037, von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W: Risk assessment for respiratory complications in paediatric anaesthesia: A prospective cohort study. The diagnosis of laryngospasm is made and treated, only to reveal persistent hypoxemia and negative-pressure pulmonary edema (NPPE). Laryngospasm is identied by varying degrees of airway obstruction with paradoxical chest move-ment, intercostal recession and tracheal tug. No chest wall movement with no breath sounds on auscultation, Inability to manually ventilate with bag-mask ventilation, ischemic end organ injury (e.g. Laryngospasm is a rare but frightening experience. Laryngospasm treatment depends on the underlying cause. J Appl Physiol 1998; 84:202035, Menon AP, Schefft GL, Thach BT: Apnea associated with regurgitation in infants. Anesthesiology. Refer to each drug's package If you think youve experienced laryngospasm, talk to your healthcare provider. Ann Otol Rhinol Laryngol 2005; 114:25863, Thach BT: Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life. The laryngospasm abates, and the patient becomes easier to ventilate. It is most commonly occurring on induction or emergence phases and can have serious life threatening consequences. Laryngospasm is an emergency situation and must be promptly recognized. Although described in the conscious state and associated with silent reflux, laryngospasm is a problematic reflex which occurs often under general anaesthesia. The next line of therapy would be to administer a low dose of succinylcholine (10Y20 mg) to relax the . Both conditions result in sudden, frightening spasms and both conditions can temporarily affect your ability to breathe and speak. Anesthesia was then maintained by facemask with 2.0% expired sevoflurane in a mixture of oxygen and nitrous oxide 50/50%. Laryngospasm, particularly during inhalational induction and after extubation, is an important cause of apnea that all anesthesiologists who care for pediatric patients should understand and anticipate. Best Pract Res Clin Anaesthesiol 2005; 19:71732, McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ: A critical review of simulation-based medical education research: 20032009. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Anesth Analg 2002; 94:4949, Reber A, Bobbi SA, Hammer J, Frei FJ: Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children. This means that if nothing has occurred 46 h after the occurrence of a laryngospasm it is likely that the course will be uneventful. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis. Among all upper airway reflexes, it is the most resistant to deepening anesthesia, whereas the coughing reflex is the most sensitive. Laryngospasm was treated by 50 mg propofol and manual positive pressure mask ventilation with 100% inspired oxygen. Von Ungern-Sternberg et al. Muscle relaxants are usually administered when initial steps of laryngospasm treatment have failed to relax the vocal cords. Laryngospasm is the sustained closure of the vocal cords resulting in the partial or complete loss of the patient's airway. This topic is beyond the scope of this article but was recently described elsewhere.37Eighty percent of negative pressure pulmonary edema cases occur within min after relief of the upper airway obstruction, but delayed onset is possible with cases reported up to 46 h later. Am J Respir Crit Care Med 1998; 157:81521, von Ungern-Sternberg BS, Boda K, Schwab C, Sims C, Johnson C, Habre W: Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. There is a need to fill this knowledge gap and to answer questions about what types of clinical education and what type of management algorithm result in better outcome. In children with URI, the use of an endotracheal tube (ETT) may increase by 11-fold the risk of respiratory adverse events, in comparison with a facemask.11Less invasive airway management could be beneficial in children with airway hyperactivity. Simulation-based Training Scenario Laryngospasm during Induction of General Anesthesia in a 10-month-old Boy. ANESTHESIOLOGY 1998; 89:12934, Reber A, Paganoni R, Frei FJ: Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children. Paediatr Anaesth 2008; 18:297302, Cohen MM, Cameron CB: Should you cancel the operation when a child has an upper respiratory tract infection? Sufficient depth of anesthesia must be achieved before direct airway stimulation is initiated (oropharyngeal airway insertion). Accessed Nov. 5, 2021. Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review. To reverse laryngospasm after surgery with anesthesia, your medical team can perform treatments to relax your vocal cords and ease your symptoms. For laryngeal closure reflex, several types of receptors can be distinguished, according to their specific sensitivities to cold, pressure, laryngeal motion, and chemical agents.19,21The chemoreceptors are sensitive to fluids with low chloride or high potassium concentrations, as well as to strong acidic or alkaline solutions.19,21. Epidemiology of Laryngospasm in Pediatric Patients Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children 1,000).2,5-7 In fact, the incidence of laryngospasm has been gery (i.e., otolaryngology surgery).2,5-7 Many factors may increase the risk of laryngospasm. Sci Transl Med 2010; 2:19cm8. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. Acta Anaesthesiol Scand 1999; 43:10813, Visvanathan T, Kluger MT, Webb RK, Westhorpe RN: Crisis management during anaesthesia: Laryngospasm. Learning objectives should be based on recommended management algorithms and used as inputs and events embedded into one (or several) case scenario that form the basis for the simulated exercise. ANESTHESIOLOGY 1956; 17:56977, Crawford MW, Rohan D, Macgowan CK, Yoo SJ, Macpherson BA: Effect of propofol anesthesia and continuous positive airway pressure on upper airway size and configuration in infants. He created the Critically Ill Airway course and teaches on numerous courses around the world. Management There are a number of ways reported to reduce the incidence of laryngospasm (9). In fact, when the inspiratory stridulous noise was noted again, the patient was receiving 2% end-tidal sevoflurane and 50% N2O, representing barely 1 minimum alveolar concentration in an infant. Accessed Nov. 5, 2021. Case Scenario Perianesthetic Management of Laryngospasm In; Hazard Identification and Risk Assessment; Permit to Work Ensuring a Safe Work Environment Introduction Industrial Workers Face Many Hazards in Their Daily Routines; Health Surveillance Employer's Pack; Incidence and Associated Factors of Laryngospasm Among Pediatric During observation, she exhibits a sudden increase in respiratory effort and noise with ventilation. If the diagnosis is laryngospasm or other vocal cord dysfunction, your doctor may refer you to a speech-language pathologist to help you learn breathing exercises. margin-top: 20px; The efficacy of lidocaine to either prevent or control extubation laryngospasm has been studied since the late 1970s.62Some articles have confirmed the efficacy of lidocaine for preventing postextubation laryngospasm, whereas others have found the opposite results to be true.16,63,,65A recent, well-conducted, randomized placebo-controlled trial in children undergoing cleft palate surgery demonstrated the effectiveness of IV lidocaine (1.5 mg/kg administered 2 min after tracheal extubation) in reducing laryngospasm and coughing (by 29.9% and 18.92%, respectively).64However, these favorable results were not confirmed in other studies.5,65The role of lidocaine (IV or topical) in preventing laryngospasm is still controversial. Causes: hypocalcemia, painful stimuli . (#2) With steroid and antibiotic, most patients will gradually improve. tracheal tug, indrawing), vomiting or desaturation. Singapore Med J 1998; 39:32830, Warner DO: Intramuscular succinylcholine and laryngospasm. Laryngospasm may not be obvious it may present as increased work of breathing (e.g. Copyright 2012, the American Society of Anesthesiologists, Inc. Perianesthetic Management of Laryngospasm in Children, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0b013e318242aae9, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Perianesthetic Dental Injuries : Frequency, Outcomes, and Risk Factors, Understanding the Mechanics of Laryngospasm Is Crucial for Proper Treatment, Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane.
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